Provider Demographics
NPI:1336719780
Name:POTEAT, MARQUIS DEON SR
Entity Type:Individual
Prefix:MR
First Name:MARQUIS
Middle Name:DEON
Last Name:POTEAT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 CHERRY BARK LOOP
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9501
Mailing Address - Country:US
Mailing Address - Phone:919-520-2542
Mailing Address - Fax:
Practice Address - Street 1:188 CHERRY BARK LOOP
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9501
Practice Address - Country:US
Practice Address - Phone:919-520-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)